Information, not advertising

Women want reliable drug information, not drug advertisements

It seems that even when we do know history, we're destined to repeat it.

In 1948, diethylstilbestrol (DES) was advertised to women as the "wonder drug" recommended for all pregnancies. The face of a cherubic infant grinned up from the pages of medical journals next to the caption: "Really? Yes, desPLEX to prevent abortion, miscarriage and premature labor...bigger and stronger babies too."

Advertising works. It worked for DES, which was prescribed to an estimated 200,000 to 400,000 pregnant women in Canada between 1941 and 1971. Despite scientific evidence from 1952 that proved DES did not prevent miscarriage, this harmful drug was advertised and prescribed for 18 more years. Only after it was linked to cancer in the daughters of women prescribed DES was it finally restricted for use in pregnancy. Those exposed to DES continue to face the effects of infertility, reproductive abnormalities and cancer decades after initial exposure, with other possible third generation effects still unknown.

But that was over 30 years ago. Surely we've learned that prescription drug advertising needs careful regulation. Apparently not.

We only have to look at the recent news surrounding the arthritis drug Vioxx that is credited with causing thousands of senseless deaths from heart attacks. During its five years on the market, its manufacturer, Merck, spent around US $500 million advertising the drug to the American public (with spillover to a Canadian audience). Vioxx was no more effective than other similar drugs to treat arthritis symptoms, it was a lot more expensive, and turned out to be much less safe.

It is time to remember the DES legacy, including the lesson that prescription drug marketing cannot continue to upstage science. And prevent the same mistakes from being made again and again.

Back in the 1950s and ‘60s, doctors were the target for most drug advertising. Direct-to-consumer advertising of prescription drugs wasn't permitted in any form in Canada. We can only imagine how many more people would have been exposed to DES if it had been promoted on television, billboards, bus shelters, newspapers and magazines as prescription drugs are today.

What many people don't realize is that direct-to-consumer advertising is still illegal in Canada, as it is in almost all industrialized countries of the world, with the exception of the United States and New Zealand. The reason we are bombarded with drug advertising in this country is that Health Canada isn't adequately enforcing the law, and companies have rushed to take advantage of this situation.

Most of us have seen the ads that slip past the border in American magazines and on cable television. But prescription drug ads created for a Canadian audience are slightly different. A 1978 amendment to The Food and Drugs Act was introduced to allow consumers to compare drug prices. Advertisers were permitted to post the drug's name, price and quantity as long as they made "no other representations." However, in November 2000, citing the 1978 price advertising clause, Health Canada published a policy paper saying that companies could advertise prescription drugs as long as they didn't include the drug's name and information on its intended use in the same ad.

The law hadn't changed — just its interpretation. Needless to say, drug companies are taking advantage of this legal loophole to introduce more and more direct-to-consumer advertising. And Health Canada is letting it happen.

So we see "help-seeking ads" that encourage the public to call a 1-800 number if they're suffering from obesity, high blood pressure, high cholesterol, sexual dysfunction and more. Or branded ads that name a drug but don't refer directly to the condition it treats. Neither type of ad fits with the intent of The Food and Drugs Act. It is not incidental that most of these ads seem to be targeted to women, all with the aim of "improving" the quality of her life – with a pharmaceutical cure.

In April 2004 in the report Opening the Medicine Cabinet, the Standing Committee on Health admonished Health Canada for a lack of enforcement and vigilance. Among other recommendations, they highlighted the need to increase transparency and improve post-market surveillance of prescription drugs; the Committee also stated that Health Canada should enforce The Food and Drugs Act by enforcing the ban on direct-to-consumer drug advertising.

Yet, as part of the current legislative renewal process at Health Canada, the department seems to be proposing the exact opposite — legalization of direct-to-consumer advertising of prescription drugs as a form of public "information."

Advertising is an effective business tool. It sells products. That's why companies spend billions of dollars each year on drug marketing budgets — a lot more than is spent on drug research and development. Women in particular are considered a lucrative market for pharmaceutical marketers, and convincing women that they need medical interventions for natural life cycles, such as menopause or aging, means profits for pharmaceutical coffers.

But advertising does not provide reliable public information. Prescription drug ads are often misleading. They downplay the risks, exaggerate benefits and imply that drugs may be used to treat a wider range of conditions than they are approved to treat. The ads also focus mainly on the newest drugs available — drugs that are usually more expensive and not necessarily the most effective or safest choice. The Vioxx example proves the point once again. With celebrity endorsements, free trial offers and emotive imagery suggesting complete relief, was the public ever really being "informed" or "educated"?

Let's quit heaping illegal advertising down the throats of Canadians who are simply looking for reliable drug information. Let's learn from the mistakes of the past and take our cue from most other industrialized nations of the world where direct-to-consumer advertising continues to be illegal.

Look to the European Parliament where an attempt to introduce direct-to-consumer advertising in 2002 was soundly rejected in the name of public health. Parliamentarians voted overwhelmingly against legalizing direct-to-consumer advertising and stated that the pharmaceutical industry was "incapable of providing impartial information on its medicines."

When will Health Canada come to the same logical conclusion? It's time to stop this drive to legalize direct-to-consumer advertising of prescription drugs in Canada — before it's a done deal.

Ellen Reynolds is the project coordinator at DES Action Canada and lives in Victoria, BC. Dr. Barbara Mintzes is a drug researcher and vice-president of DES Action Canada.

Remembering Ruth CooperstockWomen and Pharmaceuticals 20 Years Later

Mark your calendars for Tuesday, November 1st.

Women and Health Protection, in collaboration with the Ruth Cooperstock Memorial Lectureship Committee, is co-sponsoring a symposium called "Remembering Ruth Cooperstock: Women and Pharmaceuticals 20 Years Later."

"Diane, Julie, Jasmin . . . who are these women and what are they doing in your medicine cabinet?" with Barbara Mintzes

"The medicalization of women's sexuality" with Leonore Tiefer.

The workshops will be followed by a reception with light refreshments, prior to a panel discussion that will take place from 6 to 8 pm.

Panelists Connie Clement, Paula Caplan and a representative of Women and Health Protection will speak on the theme, "Women and Pharmaceuticals, where have we come from, where are we now, and where are we going?"